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Slide 1 USF Health



“ No one ever said it would be easy…”

                  Charles Paidas
                  Financial Oversight
                  August 15, 2007
                                                     The AIMS Council

Bruce Lindsey                       Chuck Paidas            Joann Strobbe
Basic Sciences                      Clinical Sciences   Finance & Administration


Michael Barber, Past Pres Faculty Council               Jim McKenzie, USF Health IT
Robert Belsole, Clinical Affairs                        Vicky Mastorides, Dean’s Office
Eric Bennett, Molecular Pharmacology & Physiology       Jean Nixon, Business Office
H. James Brownlee, Family Medicine                      Robert Nelson, Pediatrics
Karen Burdash, Clinical Finance                         John Curran, Fac/Acad. Affairs
Duane Eichler, Molecular Medicine                       William Quillen, Physical Therapy
Peter Fabri, GME                                        Abdul Rao, Research
Frank Fernandez, Psychiatry                             Paul Wallach, Education
Harvey Greenberg, DIO                                   Lynn Wecker, Research
Joseph Jackson, USFPG                                   Paula Knaus, Dean’s Office
                          AIMS: OBJECTIVES

To support College of Medicine Mission, Goals,
and Strategic Plan by:

        1) Aligning resources with missions:
           The All Source Funding Model

        2) Implementing a salary program that
          links assignment and performance to

Kickoff = March 9, 2005
      Meaningful Links

Assignment      Performance
Performance       Pay
                               The AIMS Council

                 Phase 1
COM Basic Science and Clinical Ranked
• Implement an All Source Funding Model
• Pilot College wide Performance
• Create The Data Warehouse/dashboard
• Revise the Annual Assignment and
  Evaluation Forms
                                    The AIMS Council

     Summary of Accomplishments - 1

• Established COM minimum percentages of
  effort per assignment category for ranked
  faculty with substantial input from Vice Deans
• Identified measurable College performance
  expectations for ranked faculty
• Created a plan to develop additional
  measurable Department-specific performance
  expectations for Clinical faculty
                                         The AIMS Council

    Summary of Accomplishments - 2

• Created Data warehouse and Dashboard
  -Health Analysis Reporting Tracking (HART)

• Implemented Pilot Program of Draft
  of College wide and Departmental
  performance criteria
• Established web site for transparency
                              The AIMS Council

              Future Phases
Performance expectations and evaluation
• Chairs
• Staff
• Administration
                    KEY CONCEPTS

• Faculty driven process
• Let’s learn from the pilot data
• 360° Transparency of data
• First we need to understand what we do. What
  is our definition of work?
      - Practice plan
      - Basic Science
• We have yet to arrive at an evaluation
                   KEY CONCEPTS

• Productivity not allocation
• Strategic cost assessment
      - What is the cost of doing business must
          be preceded by knowing the business.
  •How we stack up
    - internally
    - nationwide
    Pilot Departments:   2006-2007

• Psychiatry
• Pediatrics
• Family Medicine
• Basic Sciences
• Physical Therapy
                   College of Medicine Minimum Percentages of Effort for
                        Ranked Faculty (Revised by Council 3/30/06)

                      CATEGORY                                            COLLEGE - WIDE

Instruction                                                                                5%
Scholarly Activity                                                                         5%
Service/Governance                                                                         3%
Clinical Care                                                                                *
Other (Professional Development or                                                         2%
Leave of Absence with Pay)
NOTE: The minimum required workweek for 1.00 FTE Faculty is 40 hours; faculty are expected to work the number of
hours necessary to accomplish their assigned responsibilities. The minimum work year is 46 weeks or 1840 hours.
*Not applicable to Basic Science faculty. Clinical Faculty assignment will include patient care
with and without students or house staff and will be benchmarked.
             Pilot: Total Compensation For Ranked Faculty

      AIMS and                                   AIMS
    College Criteria                            Criteria
                                                                     $ 350K

                                                Incentive /                  Total
             Base                                 Bonus                   Compensation

Promotion – Assistant                             Eligibility
Associate      Full Professor                     Meets 5/5/3/2 minimum
Cost of living adjustment
New Administrative Permanent Assignment.
                                                  - Research / Scholarly Activity Criteria
If Grant is eliminated, non- tenure salary        - Education Criteria
eliminated.                                       - Clinical Criteria
ASF can decrease if clinical earnings are not     Not eligible if 5/5/3/2 not met
sufficient or department is in deficit.

Does not meet 5/5/3/2 (after PILOT)
     Systems and Quality
     Management Committee (SQMC)
SQMC Service and Clinical Metrics

           Metric            Definition   Standards Department Division   Individual   USFPG

   1. Patient satisfaction
   2. Patient complaints

   3. Patient complaints
      regarding providers
   4. Discharges of
      patients from USFGP
   5. Physician
      cancellations of
   6. Appointment
   7. USFPG Consultations

   8. Patient waiting time
      at visit
   9. Clinical measures
        Clinical Quality Indicators
• TGH Quality Indicators
  – Discharge times
  – Operative reports
       Performance Criteria for Basic
       Scientist and Clinical Faculty
•   Instruction
•   Scholarly Activity
•   Service/Governance
•   Professional Development
          AIMS Metrics (Pulmonary Division
    Metric             Definition             Base        Incentive     Bonus
                   No. of Providers x pro
  Work RVU’s                                 75th perc.    80th perc.   85th perc.
                     rata assignment
                       Annualized $’s         $2.5M         $2.7M        $3.0M
 New Program       Pulmonary initiated (at       -             -           Yes
                         year end)
                      Core Curriculum
Fellow Education                                 -             -            ?

Fellow Education   Fellow presentations         10            15           20

Medical Student    Simulator training for
                                                 -             -           Yes
  Education          Year 1 Students
Medical Student    4th Year Critical Care
                                             35 hours      60 hours     150 hours
  Education              Clerkship
           AIMS Metrics (Pulmonary Division

    Metric               Definition           Base   Incentive   Bonus

Clinical Trials –
  Pulmonary                Number              1         2         3

   Abstracts               Number              -         -         4

                    Each Year 2 or 3 Fellow
Fellow Research                                -         -        Yes
                     on Research Project

  Clinical Trial
                        Annual Dollars         -         -        $50K
     AIMS Salary Subcommitee:
     The realistic solution
for all Clinical departments:
 range = 50 – 67%
      Dean’s Tax      7%
      Corporation 20.9%
      Department      10-14%
      Division        ~ 30%


Research               Clinical
         The Tipping Point

            Rao                AIMS

      AIMS: FAQ’s from Faculty
• Everyone can be treated fairly but no one
  can be treated the same!
• All assignments are Pro rated based upon
  – {0.8 vs 1.0 vs. 0.2 FTE} x {wRVU, Education} =
    % performance effort
• If people are happy then leave them alone.
• Academic medicine means something, what
  exactly does it mean?
          AIMS: FAQ’s clinical issues
• Must understand sources of money.
     Hard money = TGH, Moffitt,
     Feds, State Contracts and State $
     Soft Money = patient revenue
• In order to increase revenue we must either:
     increase the contracts or decrease the
     expenses associated with soft money
         Team Observations during the interviews:
         “…Hey no one said it would be easy”
• AIMS is an essential element of modern day
   academic health care fiduciary responsibility
   and academic solvency.
• Life is complex in an academic world when
   we begin talking about sources and uses of
   capital (The All Source Funding Model) and
   pay for performance.
• Paucity of working knowledge about COM
   throughout faculty
• Disparity of feelings. Psychosis/Fear people
   will loose jobs. Others ecstatic !
               Team Observations
Key Survey Concepts
• Faculty driven process
•  Let’s learn from the pilot data
• First we need to understand what we do. What is
  our definition of work?
    - Practice plan
    - Basic Science
•   We have yet to arrive at an evaluation component.
•   Productivity not allocation
•   Strategic cost assessment
•   The cost of doing business must be preceded by
       knowing the business.
    – How we stack up internally and nationwide
    – 360° Transparency of data
             AIMS Summary
             SWOT Analysis
Strengths: Faculty and Chair Buy-In. Levels the
  playing field. Reward the Knowledge Worker.
  Enhance dialogue. Improves APT. LCME
Weaknesses: Talk is cheap. Don’t stop here. Will it
  control expenses? Self Reporting. Cross
  Subsidization. Unrealistic requirements. LCME
Opportunities: “Eat what you kill,” Align Sources
  and Uses of Capital. Expense Control. LCME.
Threats: Disintegration of academic spirit. Legal
  Woes. Enforce of non-Compliance. LCME
          Personal Observations
• Behavior has changed already
• Faculty beginning to become aware of
  advantages to pay for performance
• Misconceptions abound
• The title is a privilege not a right
• Repetition is key
• The pilot will help align effort, performance
  and pay
• If we don’t get our house in order someone
  else can easily do it.
             Pilot Highlights
             updated August 2007
• Clinical Activity “How you will be paid”
  – Incentive and Bonus will be wRVU based not
    dependent upon Education.
  – Appendix III and IIIa (examples)
• Instruction
  – Key phrase is educational programs = 40 hrs
  – Appendix I
          Basic Science Bonus Model August, 2007

• Basic Science Faculty are eligible for a Bonus in the following
• In addition to meeting the College-wide Base Pay performance
  requirements, must:
• meet the Bonus Pay performance requirements for Medical
  Student Instruction (Appendix I ); and,
• meet the Bonus Pay performance requirements for Graduate
  and Postdoc Instruction (Appendix II); and,
• meet the Bonus Pay performance requirements for
  Research/Scholarly Activity (Appendix IVb).
• If a faculty member does not meet all of the performance
  requirements for teaching, research and service, and performs
  at an outstanding level for two out of three of the performance
  requirements, an exception may be made to the above Bonus
  requirements with approval by the Chair and Vice Dean for
    Faculty Merit Process
    Criteria for 2006-2007

• Basic Science Ranked Faculty
• Clinician Ranked Faculty

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